Provider Demographics
NPI:1043375348
Name:PRATER, BRYAN NEALE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:NEALE
Last Name:PRATER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-9621
Mailing Address - Country:US
Mailing Address - Phone:606-759-5341
Mailing Address - Fax:606-759-7393
Practice Address - Street 1:1360 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-9621
Practice Address - Country:US
Practice Address - Phone:606-759-5341
Practice Address - Fax:606-759-7393
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17402207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3600115400Medicaid
KY6417402200Medicaid
KY6592808700Medicaid
KY7432874100Medicaid
KY7490044000Medicaid
KY7014Medicare ID - Type Unspecified
KY0701402Medicare ID - Type Unspecified
KY7432874100Medicaid
KY6592808700Medicaid
KY6417402200Medicaid